The case for nurse prescribing: in a recent New
Zealand Medical Journal editorial, two doctors claimed nurse prescribing
was a threat to the standard of health care. NZNO's professional
services manager rebuts their arguments.

The November 11 issue of The New Zealand Medical Journal contains
the Latest attack in a long history of medical opposition to nurse
prescribing. In their editorial, rheumatologist Peter Moller and
Professor Evan Begg assert that the extension of prescribing
responsibilities to nurses will threaten the standard of health care in
New Zealand. (1) They base their argument on three claims: that only
medical practitioners can diagnose and therefore prescribe appropriate
treatment; that only medical education and training prepare people to
prescribe safely; and that independent nurse prescribing goes against
the principle of good team work, which is essential for good medical
care. The fears that Moller and Begg express are unfounded. Furthermore,
their position is irresponsible because it could result in the
unwarranted undermining of public confidence in nurse prescribers.

Nurses do not believe that nurse prescribing is a threat to the
standard of health care. They believe it will raise the standard of
health care.

Right treatment at the right time

They will be able to provide prompt access to the right treatment
at the right time to many people who currently face delays in getting
access to GPs, especially in rural areas. In specialist areas, eg
diabetes and neonatal care, patients will not have to wait to get access
to drug treatment until a medical professional is available. For
"Mr Smith", a diabetes patient with high blood pressure, this
could mean that he needs to see his medical specialist consultants Less
often. Instead, his diabetes nurse practitioner (NP), who has
prescribing rights, becomes his one-stop-shop for insulin and
anti-hypertensive supplies. That is not all he can expect from her. She
will also provide a full nursing assessment, advice, support and
continuity of professional care. Prompt intervention leads to early
recovery and less cost to the health service. This means that more of
the medical consultant's time is then available for those who have
more serious and unstable illnesses. The NP will refer "Mr
Smith" to the relevant medical specialists when further medical
assessment becomes necessary. Mr Smith should expect that his NP and the
relevant medical specialists will keep each other informed and have a
dose, cordial working relationship.

Careful control of nurse prescribing will ensure patient safety.
Only those experienced nurses who have advanced, specialised
qualifications can work as an NPwith prescribing rights. Out of a total
New Zealand nursing workforce of over 35,000, fewer than 20 nurses so
far have prescribing fights.

In almost her last act as Minister of Health, Annette King gained
Cabinet approval for the regulations to implement nurse prescribing.
These came into effect on December 8. Many of Begg and Moller's
medical colleagues have supported this policy initiative through
engaging in the necessary negotiations with government, and in agreeing
to participate in the systems set up to assess, monitor and evaluate
nurse prescribing practices.

Nurses have not achieved these outcomes in splendid isolation. Nor
do they wish to prescribe in splendid isolation, as Begg and
Moller's claims would suggest. The professional initiative to
extend prescribing rights to nurses was developed over many years and
has involved consultation with many health sector colleagues, including
medical professionals.

This collaborative approach will continue and is already evident in
a number of ways. At every Level of the prescribing changes, nurses have
worked with other health professionals to ensure safety for people
needing health care. The ministerial New Prescribers Advisory Committee
(NPAC), set up to plan and implement the changes, represents both
nursing and medical expertise. A proposed medicines List for nurse
prescribers was drawn up. It was not left to nurses to decide what drugs
would be on this list. A number of parties were consulted. For example,
the College of Anaesthetists opposed the inclusion of certain
anaesthetic drugs and, as a result, NPAC deleted these drugs from the
List. Medical professionals are involved in the education of nurse
prescribers. They are also on the multi-disciplinary panel set up by the
Nursing Council to assess and monitor NPs' ability to prescribe.
Nurse prescribers can only prescribe drugs in their defined area of
practice and on the basis of Nursing Council authorisation and auditing
of their individual practising certificates. Nurses are used to working
in teams and the right to prescribe drugs will not change that practice.
It is in the interest of both patients and health professionals to work
together. It is important that each member of a team understands their
level of authority and accountability. When NPs take on the right to
prescribe drugs, they are also accepting responsibility for taking the
consequences if their drug prescribing practices are found to be
wanting. They are subject to the same kind of patient complaints systems
as medical practitioners. The public will be aware of the occasional
complaints that have been made against medical practitioners for abuse
of prescribing rights. Their nursing colleagues will expect those nurses
who do not practise safely to be judged by the same complaints systems
that judge medical practice. What nurse prescribers need from their
medical colleagues is the following:

* credit for taking on responsibility for improving health
services;

* co-operation in sustaining collaborative relationships;

* participation in sharing knowledge and improving health services;
and

* respect for what they know and can achieve. After all, nurses
have always offered these things to their medical colleagues.

* An abridged version of this article was originally published in
The Press on November 21, 2005.